Alzheimer Disease: The Daily PANCE Blueprint

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Alzheimer Disease: The Daily PANCE Blueprint

An 81-year-old female is admitted to the hospital for extreme agitation and confusion for the past few days. Per family, over the past 5 years, she also has had worsened memory. She has had trouble remembering recent events and people’s names. She has gotten lost in her neighborhood multiple times. Over the past 4 days though, she has complained of dysuria and increased urinary frequency. Her vitals and labs are unremarkable. Urinalysis is pending. The neurological exam is normal. Which of the following is the most likely cause of the patient’s worsening mentation?

A. Major depressive disorder with hyperactive delirium
B. Alzheimer's disease with superimposed delirium from a urinary tract infection
C. Delirium due to stress urinary incontinence
D. New onset schizoaffective disorder
E. Lewy body dementia

Answer and topic summary

The answer is B. Alzheimer disease with superimposed delirium from a urinary tract infection

The most common cause of dementia is Alzheimer’s disease, a neurocognitive disease characterized by diffuse neuritic plaques, amyloid-beta deposition, and neurofibrillary tangles (composed of the tau protein). Risk factors include genetics, hypertension, dyslipidemia, brain trauma, and type 2 diabetes. Signs and symptoms of Alzheimer’s disease include language / behavior changes, mood changes, declarative memory impairment, and diminished executive dysfunction. Aging in it of itself may cause some memory/cognitive decline, but red flags that point toward Alzheimer’s include: repeating the same phrase in conversations, trouble handling money, forgetting how to do easy tasks, and getting lost. Many people use the Montreal Cognitive Assessment tool to assess the degree of dementia. An MRI brain should be obtained and patients can be referred for formal neuropsychologic assessment. Pharmacological treatment options include cholinesterase inhibitors and memantine.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Neurology ⇒ Neurocognitive disorders (PEARLS) ⇒ Major/mild neurocognitive disorders

Also found on PAEA Emergency Medicine Rotation EOR topic list